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Originally posted by Dr Vinod K Joshi:
Hello John

Good to see you back. Hope all is well.
Here's a joke to make you keep smiling!

Best wishes
Vinod

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DURHAM, N.C., May 22 -- Skin reactions to a powerful new class of anti-cancer drugs are frequent, but manageable through a simple and rational treatment approach — usually without the need to reduce the dose or interrupt treatment with potentially life-prolonging chemotherapy, according to an article in the May issue of "The Oncologist." The article, entitled, "Epidermal Growth Factor Receptor (EGFR) Inhibitor-Associated Cutaneous Toxicities: an Evolving Paradigm in Clinical Management," is available online at http://theoncologist.alphamedpress.org

The special article presents the first recommendations on skin reactions to the new drugs, called Epidermal Growth Factor Receptor Inhibitors (EGFRIs). The guidelines were developed at an international multidisciplinary meeting, including medical oncologists, dermatologists, nurses, and pharmacists. "One important goal is to ensure that healthcare professionals and patients see EGFRI-associated dermatologic toxicity as manageable, thereby optimizing clinical benefit from continued and uninterrupted use of EGFRIs when possible," according to lead author Dr. Thomas J. Lynch, Jr., of Massachusetts General Hospital, Boston.

The EGFRIs carry a substantial risk of skin reactions — more than half of treated patients have some type of skin toxicity, most commonly an acne-like rash. The reactions most likely occur because the receptor blocked by the drugs also performs key functions in normal skin. Until recently, there was no strong scientific data to guide the treatment of skin reactions to EGFRIs.

To address this issue, the authors propose a simple system for classification and treatment of skin reactions. To start, all patients receiving EGFRIs are advised to use a moisturizer and protect against exposure to sunlight — the rash may be more severe in sun-exposed areas.

If skin reactions occur, a structured approach is recommended to keep the rash under control and avoid cancer treatment interruptions. Treatment is targeted to severity: mild steroids and/or antibiotics for mild reactions, stronger medications for moderate reactions. If the rash becomes severe, the guidelines call for reduction in the EGFRI dose, along with other medications. Treatment should be interrupted only if the reaction still hasn't cleared within two to four weeks. Once the rash has decreased, treatment with EGFRIs can be restarted — if the skin reaction returns, it will likely be manageable.

These expert guidelines will play an important role in helping patients and cancer care professionals to understand why EGFRI-related skin reactions occur and the logic behind their management.

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September 15, 2008 (Stockholm, Sweden) — Treating locally advanced head and neck cancers with an alternating regimen of chemotherapy and radiotherapy, in addition to cetuximab, has demonstrated promising results, researchers reported here at the 33rd European Society for Medical Oncology Congress. All of the evaluable patients in the cohort experienced a response and, aside from a high rate of localized dermatitis, toxicities were in the range of those generally observed with chemotherapy and radiotherapy in this population.

"These results are very promising but they are not controlled," commented Martine Piccart-Gebhart, MD, PhD, professor of oncology at the Université Libre de Bruxelles, in Belgium, and current president of the European Organisation for Research and Treatment of Cancer. "Now we must set up a large trial to prove that these results are valid."

from: 33rd European Society of Medical Oncology (ESMO) Congress: Abstract 694PD. Presented September 14, 2008.